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A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.
When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.
Summary: Effective April 1, 2021, this amendment updates the physician office and outpatient fee schedule to incorporate various Healthcare Common Procedure Coding System (HCPCS) updates (additions, deletions and description changes) from the most recent HCPCS quarterly update issued by CMS. Codes that are being added are being priced using a comparable methodology to other codes in the same or similar category.
Summary: Effective April 1, 2021, this amendment updates the DME fee schedule to incorporate the April 2021 Healthcare Common Procedure Coding System (HCPCS) changes to remain compliant with the Health Insurance Portability and Accountability Act (HIPPA). Newly added codes are priced using a comparable methodology to other codes in the same or similar category.
Summary: Effective October 1, 2020 until September 30, 2025, pursuant to 1905(a)(29) of the Social Security Act and Section 1106(b) of the SUPPORT Act, this amendment adds the medication-assisted treatment (MAT) as a mandatory benefit in the Medicaid state plan.
Summary: Effective July 1, 2021, this amendment establishes an ambulance transportation quality assurance fee program that will provide an add-on to fee-for-service emergency ambulance rates for non-public and non-federal emergency ambulance transportation providers. The add-on rate will be funded solely from assessments to the same providers. This assessment and add-on rate will not apply to any unit of government as defined in 42 CFR Sec 13 433.50, including federally recognized Indian tribes.
Summary: Effective January 1, 2021, this amendment adopts a new resource disregard under the authority of section 1902(r)(2) of the Social Security Act. The agency chooses to provide a reasonable timeframe for reducing excess resources accumulated during the COVID-19 public health emergency (PHE) by certain individuals subject to the post-eligibility treatment of income (PETI) rules for long-term services and supports (LTSS). Under FFCRA, these individuals accumulated extra resources, due to no changes being made to their PETI. Income they would have otherwise paid toward the cost of their care resulted in an increase in their resources that began to exceed program standards. This methodology also will prevent an institutionalized beneficiary from having to spend down any such excess resources during the PHE. This methodology will remain in effect through the twelve months following the end of the COVID-19 PHE.
Summary: Effective April 1, 2021, this amendment updated the fee schedule effective dates for several Medicaid programs and services. This is a regular, budget neutral update.
Summary: Effective January 1, 2021, this plan amendment revises the Medical Clinic, Family Planning Clinic, Behavioral Health Clinic, Rehabilitation Clinic, and Ambulatory Surgical Center fee schedules.
Summary: Effective January 1, 2021, this plan amendment revises the Independent Audiology fee schedule. These revisions incorporate the 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to remain compliant with the Health Insurance Portability and Accountability Act (HIPAA)
Summary: Effective January 1, 2021, this plan amendment updated the dental fee schedules for adults and children. These updates incorporate various 2021 Healthcare Common Procedural Coding System (HCPCS) changes (additions, deletions and description changes) to remain compliant with the Health Insurance Portability and Accountability Act (HIPAA).
